Gastroesophageal junction

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Author: Mikael Häggström [note 1]

Endoscopic biopsies   edit


On this resource, the following formatting is used for comprehensiveness:

  • Minimal depth
  • (Moderate depth)
  • ((Comprehensive))

Microscopic examination

The main findings to look for are:

Barrett's esophagus

The main diagnostic sign of Barrett's esophagus is the presence of goblet cells. A true goblet cell should have rounded shape, clear to bluish cytoplasmic mucin, and be randomly scattered.[1] The mucin usually indents the nucleus.[1]

Further information: Barrett's esophagus


GE junction with chronic esophagitis, including plasma cells (black arrow), an acute inflammation with neutrophils (white arrow), as well as basal layer hyperplasia (yellow double-headed arrow).

Look for signs of (reflux) esophagitis, mainly:[2]

  • Inflammatory cells, especially when intra-epithelial. Neutrophils confer a diagnosis of acute inflammation, while plasma cells, eosinophils and excess T cells confer a diagnosis of chronic inflammation. In eosinophil-predominant inflammation, also evaluate as suspected eosinophilic esophagitis.
  • Basal cell hyperplasia exceeding 15 - 20% of the epithelial thickness.
  • Stromal papillae reaching upper third of the epithelium.
  • Loss of orientation of superficial epithelial cells.
  • Ballooned squamous cells


(Document the type of mucosa:

  • If both gastric and squamous mucosa is present in the same fragment, report as "Gastroesophageal junctional mucosa with..."
  • If not, report the presence of squamous and/or gastric mucosa.)


(GE junction, biopsy:)
Squamous mucosa without significant histopathologic changes.
(Negative for gastric mucosa or intestinalized (Barrett's) mucosa.)
(GE junction, biopsy:)
Gastroesophageal junctional mucosa with chronic inflammation and reactive changes(, non-specific.
Negative for intestinalized (Barrett's) mucosa.)

In case of multiple signs of reflux esophagitis:

(GE junction, biopsy:)
Gastroesophageal junctional mucosa with changes consistent with reflux esophagitis.
(Negative for intestinalized (Barrett's) mucosa.)


  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page


  1. 1.0 1.1 Dipti M. Karamchandani. Esophagus - Premalignant - Barrett esophagus. Topic Completed: 19 March 2020, Minor changes: 29 June 2020
  2. Elliot Weisenberg. Esophagus - Esophagitis - Reflux esophagitis / gastroesophageal reflux disease. Pathology Outlines. Topic Completed: 1 October 2012. Minor changes: 8 July 2020

Image sources